Wiki Smitt sleeve

[MaryDx]

Not sure if this is correct - but this info doesn't seem to be easily found on the internet. If a provider inserts a Smitt Sleeve (CPT 57156) on the same day that another provider inserts the tandem and/or vaginal ovoids for clinical brachytherapy (CPT 57155), then CPT 57156 would be considered a mututally exclusive procedure. Would it be correct to bill the unlisted code 58999 for the provider who did the work of CPT 57156 for reimbursement?


Thank you!

 

[Anastasia]

Use a -62 modifier on the 57156. The other provider should do so as well.

 

[MaryDx]

Thanks Anastasia - appreciate you taking the time to answer. I might not have been clear with my question - these procedures were done separately and at completely different times, so I'm not sure mod 62 could be utilized.

 

[bunkie717]

Removal of Smitt Sleeve

Is the removal of the Smit sleeve bundled with the placement?

 

[Cmama12]

If a provider inserts a Smitt Sleeve (CPT 57156) on the same day that another provider inserts the tandem and/or vaginal ovoids for clinical brachytherapy (CPT 57155), then CPT 57156 would be considered a mututally exclusive procedure

This is an old thread but I felt compelled to correct this. Placement of a Smit sleeve is part of CPT 57155 for placement of tandem/vaginal ovids. If performed by a gyn onc and a radiation onc at the same session, this should be billed 57155-62. Guidance regarding this can be found on the SGO website. 57156 represents placement of a vaginal cylinder not a Smit sleeve. The cylinder is then connected to a machine that delivers the radiation therapy. They are similar but different.

 

[nielynco]

Not sure if this is correct - but this info doesn't seem to be easily found on the internet. If a provider inserts a Smitt Sleeve (CPT 57156) on the same day that another provider inserts the tandem and/or vaginal ovoids for clinical brachytherapy (CPT 57155), then CPT 57156 would be considered a mututally exclusive procedure. Would it be correct to bill the unlisted code 58999 for the provider who did the work of CPT 57156 for reimbursement?


Thank you!

If each physician (not related in practice to each other) performed a different procedure you bill only what the provider you are billing for did. A modifier -62 would only be required if both providers inserted the Smitt sleeve, not when each does something different. We answered a reader question on this subject back in 2003 before 57156 was added. Here is what we said:

If the ob-gyn only places the Smitt sleeve and does not place the tandem and ovoids at the same time, you should report 58999 (Unlisted procedure, female genital system [nonobstetrical]) because CPT does not contain a code that specifically represents this procedure. If the doctor inserts the sleeve at the same time as the tandem and ovoids, you can bill this as 57155 (Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy) appended with modifier -22 (Unusual procedural services) to show the extra work involved.

And for those readers who may be wondering….Physicians generally deliver brachytherapy for early stage cervical cancer using an applicator called a tandem and ovoids. Before the first treatment, the doctor may place a Smitt sleeve intraoperatively. The Smitt sleeve is a hollow plastic tube that is fitted to the length of the uterine cavity. The physician inserts it through the cervical opening into the uterus, and then sutures it into place on the cervix. This sleeve stays in the uterus for all the treatments.

The Smitt sleeve keeps the cervix open, allowing for comfortable and accurate positioning of the tandem. The tandem is a hollow metal tube that will temporarily hold the radioactive source, which the physician inserts into the Smitt sleeve. The doctor places the two ovoids on either side of the cervix at the top of the vagina. They also will hold the radioactive source during treatment. Tiny radiation shields in the ovoids reduce the radiation doses to the bladder and rectum.